might want to take a look at Bob Wachter’s post over at Wacther’s World. http://community.the-hospitalist.org/blogs/wachters_world/archive/2010/07/08/why-obama-made-the-right-call-on-berwick.aspx. There, the Associate Chairman of the Department of Medicine at the University of California, San Francisco, makes the most persuasive and cogent case I’ve seen as to why the recess appointment made sense.
Wachter writes: “The very things that make Berwick right for the CMS role also make him a target in today’s political environment, where all serious debate is trivialized and caricatured via talking points and schoolyard name calling. . . . Obama did not bypass a substantive airing of Berwick’s qualifications to run the most important healthcare organization in the country. Rather, he avoided a sandbox brawl.”
Berwick could have handled the fight, but I'm glad the American public was spared the spectacle of watching their elected representatives turn themselves into trolls on C-Span. We've already witnessed a year of ugly debate on healthcare reform.
I don’t mind recess appt.’s so much as I mind the total lack of communication between the two parties. It seems that squeaky wheels are running the show on both sides of the aisle. This makes for interesting entertainment on talk radio, but basically neuters our countries ability to operate in the fashion our founding fathers imagined. Why can’t the moderates in each party make as much “noise” as those who cry foul on a daily basis from capitol hill? It seems the extremists are too busy passifying those who elected them, to govern in a way that would actually lead to common sense decision making and law writing.
Healthcare, which affects so many, will suffer from this grandstanding. Hopefully, this guy will do a good job and the way he was given his job, won’t ever become an issue. Here’s hoping for someone who cares more about the patient than reading his own headlines.
Stop smoking–
You ask why the moderates on both sides don’t speak up.
I’m afraid I can’t name 5 moderate Republicans in Congress.
This is not because Republicans are, by definition, extremists.
It’s because during the last 15 years, Karl Rove and the Bush administraiton drove moderate Republicans out of the party.
In the past, there were always a number of moderate Republican Congressmen whom I admired–but they’re gone and have been replaced with hard-line right-wingers.
The Democrats have both moderates and liberals in Congress, coming
-from “red states” and “blue states”.
At the ame time, there are relatively few truly progressive liberal Democrats in Congress. Here, I’m thinking of people like Ted Kennedy. In the 1990s, the Democrats moved to the right, as they tried to compromise with the Republicans. The Democrats moved away from their traditional base (the statisical middle class– i.e., people earning median income, or less, blue-collar workers, and minoriites. In the 1990s , the Democrats were trying to attract more upper-middle-class suburbanites.
As for lack of communication: the conservative Republcians aren’t willing to talk about compromise– even with what is a pretty moderate Democratic party.
Obama really did bend over backwards to try to meet the Republcians half-way. He wound up making concessions to the moderate Democrats –the Republicans just wouldn’t deal.
As the bi-partisan forum broadcast on C-Span made clear, Republicans did not want to provide coverage for 37 million uninsured Americans. They proposed covering about 3 million.
From their point of view, health care is simply not a right; and it’s not something that a civilized society has a responsiblity to provide to all of its citizens.
In the face of that brick wall, I’m not sure what Obama or other Democrats could say.
I’m not I’m anti-Republican (I’ve never defined myself as a Democrat, but simply as a liberal/ progressivel), but because I’m very sorry to see what has happened to the Republican party in recent years.
The woman that the Republican leadership has chosen to run against Reid in Nevada is, I’m afraid, a symbol of what has happened to the Republican party. She’s an embarassment–to women, to Americans of all parties..
I’m just hoping that this fall, conservative Republicans in some states will be defeated by more moderate Republicans running against them in primaries.
If we’re going to have a true, substantive dialogue about issues, we also need more moderate and liberal intelligent Independents in Congress.
Maggie,
You’ve hit the nail on the head with your description of what happened to the Republican Party.
I was a Republican ever since I first registered to vote, mostly on fiscal issues (less the social ones). I fit the definition of a moderate Republican.
I got sick of the pandering to corporate interests and ultra social conservatives (whose hypocrisy I simply cannot stand).
Until the GOP regains its senses, I will not return to the fold. I’m not holding my breath.
Panacea–
Thank you.
I, too, remember moderate Republicans. Today we have
a handful at the state or local level (Mike Bloomberg, for instance, though he’s really neither a Democrat nor a Republican).
If Republican party leaders don’t regain their senses, my guess is that Independents–or a party that grows out of the Independents–will become more powerful.
Lack of communication is a big problem in the modern world. The big media companies are not doing their job. That has an effect on the whole health care mess too.
Health Courage–
I agree. Rather than explaining the issues clearly, the media lapses into the same “sound bites,” ripped out of context, that are so misleading: “death panels”
“Medicare melt-down” etc.
The media could have explained that there was no way Congress going to slash reimbursements to docs by 23% across the board–and also explained how and why the threat made doctors nervous and caused cash flow problems when full payment was delayed, even for 10 days.
The media could have done a better job of finding politicians willing to talk rationally about the pros and cons of health care legislation–and how, if we didn’t do something, healthcare was going to become unaffordable.
They could have explained why health care bills are soaring–rather than just pinning blame on the insurers. Everyone has been complicit.
Of course there has been some excellent reporting, some excellent articles and posts in the blogosphere. But not enough. And the meida has become a platform for spreading far too much misinformation.
.
Agree-Maggie
Are the Republicans still trying to reverse the Berwick recess appointment?
Do they have any procedural grounds?
Thanks,
Dr. Rick Lippin
Southampton,Pa
Maggie — Thanks for the post and link to Bob Wachter’s. You both nail why a recess appointment for Don Berwick had to be done. As a self- confessed “extremist” for patient-centered care, he is the right person to head CMS in face of those who promulgate the Death Panel lies and myth and who ignore the huge systemic problems of US health care.
Jim–
Thank you.
Today I met with some people involved with funding and helping Community Health Centers improve systems and delivery of care.
As they pointed out, already, on the ground, things are moving toward the idea of patient-centered care, continuity of care and medical homes.
Maggie —
Thanks for your reply to my comment. It’s tremendously encouraging to hear about your meeting yesterday with people involved with funding and helping Community Health Centers to improve systems and delivery of care. I am convinced that the more that the public knows about patient-centered care, continuity of care, and medical homes, the more they will ask for it. We need to create the supply, and we need to encourage the demand.
You may be aware that late last year Diane Meier of the Center to Advance Palliative Care held a substantive roundtable discussion of palliative care experts that was published in the Journal of Palliative Medicine. One of the things that Diane said was, “I think most people—they may not be the ones that are on Fox News and they may not be the ones who get the headlines— but that most people recognize that the death panel rhetoric was hyperbolic, overblown, and being used for political purposes. So in the end, while I was quite worried when it was happening, I think we may have actually enhanced public awareness of the importance of palliative care as a result of all the attention that was given to this issue in August.”
Now if only more people – including many in the medical profession – can come to recognize that palliative care applies at any stage of a serious illness, whether it is potentially curable, chronic or life-threatening, and that hospice care is always palliative, but not all palliative care is hospice care.
Accomplishing that is going to take time and a lot of resources for education and advocacy. But I think that the momentum is positive and that many people within the health care field are – on their own and in concert with others as much as possible — pulling in the same direction.
Jim-
Thanks very much. I agree completely.
Diane Meier has edited a book on palliative care that I plan to write about soon.